It's not just the Therapist: Therapist and Country-Wide Experience Predict Therapist Adherence and Adolescent Outcome

Staff Perceptions and Implementation Fidelity of an Autism Spectrum Disorder Care Pathway on a Child/Adolescent General Psychiatric Inpatient Service

While youth with autism spectrum disorder (ASD) are psychiatrically hospitalized at high rates, general psychiatric settings are not designed to meet their unique needs. Previous evaluations of an ASD-Care Pathway (ASD-CP) on a general psychiatric unit revealed sustained reductions in crisis interventions (intramuscular medication use, holds/restraints; Cervantes et al. in J Autism Dev Disord 49(8):3173-3180, https://doi.org/10.1007/s10803-019-04029-6 , 2019; Kuriakose et al. in J Autism Dev Disord 48(12):4082-4089, https://doi.org/10.1007/s10803-018-3666-y , 2018). The current study investigated staff perceptions of the ASD-CP (N = 30), and examined rates of ASD-CP implementation fidelity in relation to patient outcomes (N = 28). Staff identified visual communication aids and reward strategies as most helpful. The number of days of reward identification early in the inpatient stay was associated with fewer crisis interventions later in a patient's stay.

Systematic literature review and meta-analysis of the relationship between adherence, competence and outcome in psychotherapy for children and adolescents

The extent to which therapist adherence to guidelines and clinician skill or competence may play a role in the prediction of therapeutic outcomes remains inconclusive. This systematic literature review and meta-analysis considers whether adherence or competence predicts youth outcome in child and adolescent psychotherapy, and whether there are any identifiable factors which moderate the strength or direction of this relationship. A systematic literature search identified 35 studies in 52 papers. The studies contained 29 effect sizes for the relationship between adherence and outcome, while nine effect sizes were extracted for competence, and a further five effects measured a composite of adherence and competence constructs, referred to as fidelity in this report. The meta-analysis indicated a small but significant relationship between therapist adherence and outcome, although the small size of effect suggests that outcomes are likely to be more strongly associated with factors other than adherence. No significant relationship was identified between competence or composite fidelity and outcome. Although variance was observed in effect sizes, no significant moderation by client group, intervention type, or implementation measure informant was identified. Further study is needed to understand the specific circumstances under which adherence and outcome are related.

Treatment Outcomes of a Shortened Secure Residential Stay Combined With Multisystemic Therapy: A Pilot Study

ThuisBest is a newly developed family focused treatment that combines secure residential youth care with multisystemic therapy (MST), allowing adolescents to return home after secure residential youth care more quickly. The purpose of this pilot study was to examine treatment outcomes for adolescents in ThuisBest (n = 86, M_age = 15.2 years, 63% boys) and to what degree those treatment outcomes could be predicted by client characteristics. The results showed that externalizing behavior problems and parenting stress had decreased at the end of treatment. After ThuisBest, 83% of the adolescents did not have new police contact, 72% lived at home, and 89% attended school or work. Almost none of the treatment outcomes could be predicted by any of the client characteristics. ThuisBest seems a promising trajectory, as it reduces the length of the stay in secure residential youth care, and may, therefore, be more cost-effective than standard secure residential youth care. However, given the lack of a control-group and follow-up data, findings must be interpreted as preliminary.

Pivotal response treatment: A study into the relationship between therapist characteristics and fidelity of implementation

In this study, we investigated the relationship between fidelity of pivotal response treatment implementation and therapist characteristics, such as therapist personality, therapist–child relationship, therapist attitude toward evidence-based practices, and therapist experience. We also explored whether child age and autism symptom severity were related to pivotal response treatment fidelity. Participants were 41 level III certified pivotal response treatment therapists who recorded three 10-min pivotal response treatment sessions and completed four questionnaires to measure therapist characteristics. Results indicated that therapists’ attitude toward evidence-based practices, specifically openness to innovation, and therapists’ experience with pivotal response treatment significantly predicted fidelity of pivotal response treatment implementation. Cross-validation methods largely confirmed these findings. Therapist personality, therapist–child relationship, and child characteristics were not significantly related to pivotal response treatment fidelity. Implications for clinical practice and directions for future research are discussed.

Development of Therapist Adherence in Relation to Treatment Outcomes of Adolescents with Behavioral Problems

Therapist adherence to the treatment manual is assumed to be crucial for adequate implementation and subsequent achievement of the intended, positive treatment outcomes. Although adherence has been mostly studied as a static factor, recent studies suggest that adherence might be dynamic and changes over time. We investigated how parent-perceived adherence to the multisystemic therapy (MST) model develops during treatment and how this development is related to treatment outcomes up to 18 months posttreatment, controlling for the effect of alliance. We used routinely collected data from 848 adolescents (66% male and 76% Western, M age = 15.25 years) and their caregivers participating in MST, a family- and community-based intervention for antisocial adolescents. Adherence and alliance were measured monthly through phone interviews with the caregivers using the Therapist Adherence Measure-Revised. Outcomes were assessed at the end of the treatment and at 18 months posttreatment using the scale Rule-Breaking Behavior of the Child Behavior Checklist and two MST Ultimate Outcomes (i.e., police contact and out-of-home placement). On average, adherence showed an increasing and then flattening slope. The initial level of adherence predicted treatment outcomes at the end of treatment but not at 18 months posttreatment. Change in adherence did not predict treatment outcomes after controlling for alliance. We advocate the need to consider the dynamic nature of adherence in research as well as clinical practice. Change in adherence during treatment, as well as its association with outcome, is likely to be dependent on the adherence measure being used.